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Non‐invasive model predicting clinically‐significant portal hypertension in patients with advanced fibrosis
Author(s) -
Park Seung Ha,
Park Tae Eun,
Kim Young Mook,
Kim Sung Jung,
Baik Gwang Ho,
Kim Jin Bong,
Kim Dong Joon
Publication year - 2009
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2009.05904.x
Subject(s) - medicine , portal hypertension , esophageal varices , portal venous pressure , gastroenterology , varices , confidence interval , receiver operating characteristic , cirrhosis , fibrosis , liver biopsy , gastric varices , area under the curve , biopsy
Background and Aims: Hepatic venous pressure gradient (HVPG) has been established as a predictor for the development of varices, clinical decompensation and death. In the present study, the primary objectives were to determine the diagnostic accuracy of the model developed by using readily‐available data in predicting the presence of significant portal hypertension and esophageal varices. Methods: This study included a total of 61 consecutive treatment‐naive patients with advanced fibrosis (METAVIR F3, F4), established by liver biopsy. All patients underwent subsequent HVPG measurement and upper gastrointestinal endoscopy within 1 week of liver biopsy. Results: Seventeen patients (F3, 2/26; F4, 15/35) had clinically‐significant portal hypertension (HVPG ≥ 10 mmHg). The Risk Score for predicting significant portal hypertension was 14.2 − 7.1 × log 10 (platelet [10 9 /L]) + 4.2 × log 10 (bilirubin [mg/dL]). The area under the receiver–operator curve (AUC) curve was 0.91 (95% confidence interval [CI], 0.84–0.98). The optimized cut‐off value (Risk Score = −1.0) offered a sensitivity of 88% (95% CI, 62–98%) and a specificity of 86% (95% CI, 72–94%). The AUC of the Risk Score in predicting varices was 0.82 (95% CI, 0.67–0.98). The cut‐off had a sensitivity of 82% (95% CI, 48–97%) and a specificity of 76% (95% CI, 62–86%). Conclusion: A predictive model that uses readily‐available laboratory results may reliably identify advanced fibrosis patients with clinically‐significant portal hypertension as well as esophageal varices. However, before accepted, the results of the current study certainly should be validated in larger prospective cohorts.